2015-08-03T00:26:58ZExploring the impact of the lung cancer Clinical Nurse Specialist role on patient care in a regional hospital in New Zealandhttp://hdl.handle.net/10523/5793
Exploring the impact of the lung cancer Clinical Nurse Specialist role on patient care in a regional hospital in New Zealand
2015
Tewin, Maureen Heather
Back Ground
The aging population and the need for health systems to manage an ever increasing numbers of patients with chronic conditions has been identified as one of the greatest challenges for health care providers worldwide. New Zealand is no exception, with chronic conditions causing over 80% of all deaths per year (Connolly et al., 2010). Cancer is one such chronic condition, where, the devastating effect of a diagnosis is often coupled with difficulties in navigating the complex health care setting. Hence some areas have seen the development of specialized nursing roles to accommodate the needs of this group of patients. One such role to emerge is that of the Lung Cancer Clinical Nurse Specialist. The question naturally arises as to whether such nurses are indeed assisting patients and demonstrating Advanced Nursing Practice (ANP) in the care they give. Within the literature it is suggested that an evaluation of these roles is necessary, if they are to be fully recognised and valued (Bryant-Lukosius, DiCenso, Browne & Pinelli, 2004; Oliver & Leary, 2012; Vaz & Small, 2007). It is to this area that this study is directed.
Aim
The aim of this study was to explore the impact of an advanced nursing role on lung cancer patient care. In particular eliciting information regarding the functionality of the Clinical Nurse Specialist (CNS) role within the multi-disciplinary team (MDT) within a regional lung cancer service was an important aspect of the research.
Method
There was a need for the study to provide insight into how the role of the Lung Cancer Clinical Nurse Specialist (LC CNS) was viewed and understood by those that work with them (Cowman et al., 2010; Moore et al. 2006).
Phase one was a questionnaire which was sent out to 50 members of the MDT, with the express purpose to elicit information from a variety of health professionals. The questionnaire contained both quantitative and qualitative questions.
Phase two was an audit which involved a quantitative observational, retrospective study of five months of clinical data relating to patients cared for by the LC CNS’s. The data was audited against the Standards of Service Provision for Lung cancer Patients in New Zealand (MOH, 2011)
Findings
From the respondents questionnaire (76%. N=38) the overall opinion was that the LC CNS role was meeting the expected standards. The audit data revealed an age range of patients from 41-79yrs with a median of 60yrs. In terms of the LC CNS the audit data likewise suggested that the role was being fulfilled as expected including psychosocial support, provision of information and care co-ordination.
Conclusion
The LC CNS role clearly fulfills the expectation of the MOH Standards, the MDT with whom they work identify the role as crucial and have suggested that the LC CNS’s are the “glue that makes the system work much better and be more patient centered”. There is recognition that planning is essential when developing advanced nursing practice (ANP) roles, to ensure robust processes are put in place at the beginning of the process. There is evidence that development of these roles in an ad hoc fashion can lead to confusion regarding the intention of the role. The nurses who work within these ANP roles must be able to articulate and clearly define their role (Lewandowski & Adamle, 2009). There is also a need to evaluate the effectiveness of the role, as without robust evaluation there is a tendency to underestimate their crucial clinical contribution Oliver & Leary, 2012).
2015-07-09T21:15:25ZWomen’s motivation to perform pelvic floor muscle training for prevention of pelvic organ prolapsehttp://hdl.handle.net/10523/5773
Women’s motivation to perform pelvic floor muscle training for prevention of pelvic organ prolapse
2015
Macfarlane, Emma Rose
Pelvic organ prolapse (POP) is associated with decreased physical, psychological, and sexual health. Pelvic floor muscle training (PFMT) is an effective treatment for POP and other pelvic floor dysfunctions (such as urinary incontinence) and there is some evidence PFMT may help prevent POP. However, poor exercise adherence is a major barrier to PFMT effectiveness. Investigating women’s motivation for PFMT to prevent POP may elicit useful insights into how clinicians can assist women to effectively incorporate into PFMT into their lives.
Using case study methodology, and a theoretical proposition based on Pender’s Health Promotion Model, the influences on women’s motivation to start and continue (or not) PFMT for prevention of POP was explored. The theoretical proposition was that; there are internal and external influences that affect women’s choices about performing PFMT, and it is the way that these influences are motivating or not that affect their choice. Influences may not be the same for every woman and nor is the degree to which they may, or may not, act as a motivator. Case one was comprised of two women (both previous participants in a trial of PFMT for prevention of POP) and the physiotherapist who provided treatment. Case two was a Family Planning client and the female doctor who, during the course of clinical assessment, identified the woman had asymptomatic POP.
Transcripts from the semi-structured interviews were analysed according to the principles of case study methodology. Analysis began with explanation building within each case; data were coded for meaning and then categorised (deductively) according to the main concepts in Pender’s HPM. Inductive categories were derived for data that did not map to the model and rival theoretical explanations (Bandura’s Social Cognitive Theory, Ajzen’s Theory of Planned Behaviour and Protection Motivation Theory) for these data were considered. Cross case analysis compared the two cases relative to the theoretical proposition.
Three key influences on motivation were identified; (1) The woman’s socio-cultural context, (2) PFMT self-efficacy, (3) Health promotion delivery. The first described how a woman’s attitudes, beliefs, knowledge and choices about PFMT are situated within her socio-cultural context that include influences such as taboos about discussing genital health, beliefs about health priorities, and spousal/family relationships. For the second, knowledge and skills were an important starting point yet personal agency and expectancy outcomes are necessary to initiate and maintain PFMT as a health promoting behaviour. The third influence captured the clinicians’ role in providing a context that enables sharing of sensitive information and supporting women to achieve self-efficacy. The ‘incidental’ finding of POP in the Family Planning environment was associated with particular difficulties for supporting the client to achieve PFMT self-efficacy and thus the effectiveness of the health promoting moment was compromised.
Public health education to increase awareness of POP and provide women with PFMT skills is needed to enable them to adopt PFMT as a health promoting behaviour. Clinicians working in primary care, particularly in women’s health contexts such as Family Planning, potentially have a major role to play in implementing such initiatives.
2015-07-06T21:03:23ZSupportive care needs of patients with colorectal cancer and their families in Iran and New Zealandhttp://hdl.handle.net/10523/5747
Supportive care needs of patients with colorectal cancer and their families in Iran and New Zealand
2015
Nejat, Nazi
Introduction
Colorectal cancer (CRC) is one of the most common cancers and a leading cause of cancer death in Iran and New Zealand. Little is known about the supportive care needs (SCNs) for patients with CRC and their families, cancer survivors’ experiences during different phases of the cancer journey or whether these needs are met. Understanding SCNs is important to guide cancer treatment, care and development of cancer care services. Additionally, the literature suggests reported SCNs are related to culture, delivery of cancer care services, and personal factors. The focus of this thesis was to explore the SCNs of individuals with CRC undergoing cancer treatment and their families in Iran and New Zealand, and to identify any differences between patients and their families’ priority of needs in both countries.
Method
The design of this study was a qualitatively driven, convergent mixed method research study, incorporating a parallel quantitative component. Participants were recruited from two tertiary hospitals, one in Iran and one in New Zealand. A total of 80 people participated in this study, 47 from Iran and 33 from New Zealand.
Supportive care needs of participants were measured by the Supportive Care Needs Survey-Short Form (SCNS-SF34) and the Spiritual Needs Questionnaire (SpNQ), and the Supportive Care Needs Survey for partner and caregivers SCNS-P&C39 for family participants). A semi-structured interview was conducted followed with the descriptive cross-sectional survey to gain more detail about both groups of participants’ supportive care needs. Data from quantitative and qualitative approaches were analysed using descriptive statistics and content analysis respectively.
Results
Iranian participants expressed higher SCNs in all dimensions except for the dimension of psychological needs, where SCNs were equal to those of New Zealand participants. Iranian participants used spiritual/religious resources more often and received more support from their families while New Zealand participants demonstrated a greater reliance on the health care system. The health system/information, psychological and financial domains were reported as the highest areas of needs by Iranian participants, while for New Zealand participants, SCNs in the physical and psychological domains were more common.
Iranian family participants expressed higher SCNs in all dimensions when compared to New Zealand family participants except for the dimension of psychological needs where SCNs were equal to those of New Zealand family participants. Iranian family participants used spiritual/religious resources more often and received more support from their families, while New Zealand family participants demonstrated a greater reliance on the health care system. Iranian family participants reported the informational, psychological and financial domains as the highest areas of needs while New Zealand family participants reported the psychological and informational domains as the areas of highest unmet needs.
Religious beliefs and activities and spiritual beliefs and powers were reported by participants as resources in dealing with cancer. This study found that religion did not play a major role in coping with cancer for New Zealand participants, whilst religion played a major role in coping for participants in Iran. The use of spirituality as a resource in managing cancer was only reported by New Zealand participants.
Discussion
This study has generated insight into the perceived SCNs of patients and their families during the treatment phase of the cancer journey in New Zealand and Iran. Differences and similarities between perceived SCNs and supportive care resources in Iran and New Zealand were noted. The similarities between SCNs may be related to cancer as a life-threatening disease; a universal phenomenon. Differences between SCNs and use of supportive resources may be related to differences in culture, provision of oncology services, and the health care system in Iran and New Zealand.
These findings are important as they suggest that patients with CRC and their families in both countries experienced unmet SCNs, and, further indicates how well cancer care services met participants’ SCNs. Additionally, these findings provide knowledge on resources that patients and their families used to cope with their cancer journey. The findings provide some direction to inform the development of cancer care services, especially in the provision of supportive care based on culture and health care provision, and inform recommendation for an integrated approach to the supportive care provision.
2015-06-28T23:44:46ZWhat are the supportive care needs of colorectal cancer patients throughout their cancer journey?http://hdl.handle.net/10523/5534
What are the supportive care needs of colorectal cancer patients throughout their cancer journey?
2015
Francis, Karen
Colorectal cancer (CRC) is now the third most common malignancy for men and women in New Zealand. The efficacy of surgical and oncological treatment options for CRC continue to develop and improve patients overall survival outcomes. As the projected growth of the aging population in New Zealand is set to rise significantly over the next ten years, there will be an exponential increase in CRC diagnoses. Therefore, in the future NZ will have a large population of CRC survivors. The vision of the Ministry of Health (MOH, 2013a) is to improve the patients’ experience of cancer with an emphasis on enhancing supportive care needs throughout the cancer trajectory. The Cancer Nurse Coordinator (CNC) initiative has been designed to help improve the patients experience by facilitating timely care and providing the patient and family with support and guidance during the cancer trajectory.
The aim of this research was to identify the supportive care needs of CRC patients throughout the cancer trajectory. With a specific focus on understanding the patients’ perspective of any physical, social, emotional and spiritual issues experienced. This study used data collected through two focus groups. A general inductive approach was used to analyse the data. Four themes were generated from the data (communication and information, living beyond cancer, coping strategies and family support). Each main theme produced sub-themes and these are illustrated with patient narratives to reflect the participant’s perspective of supportive care needs.
The results of the study identified that communication and information were fundamental components of supportive care. Physical, spiritual, emotional and social well-being were acknowledged as varying from person to person and fluctuated throughout the cancer trajectory. These themes were not experienced in isolation; they interconnected and influenced the patients overall well-being. Supportive care needs were evident throughout the cancer trajectory. However, were intensified at the point of diagnosis, during treatment and transition into life beyond cancer. Patients and family members were dependant on health professionals for support within the health care environment and the quality of this support varied, impacting on overall well-being. In the community setting patients received the majority of support from family and friends.
This study has provided insight into individual supportive care needs experienced by CRC patient’s throughout the cancer trajectory. Living with, through and beyond CRC treatment can create specific immediate and long-term symptoms which may impact on a patient’s quality of life. The role of the CNC can go some way to help facilitate quality supportive care improvements within the health care environment. With better support, the well-being of patients and family will be enhanced during their cancer experience.
2015-03-16T02:25:36ZThe quiet room. A narrative analysis of elderly widowed people's perspectives of loneliness.http://hdl.handle.net/10523/5437
The quiet room. A narrative analysis of elderly widowed people's perspectives of loneliness.
2015
Davies-Kelly, Nicola
This thesis is the culmination of a Doctoral research project undertaken through the Postgraduate Nursing Department, Otago University. The aim was to retell the story of the experience of loneliness from the perspectives of older widows and widowers living in the wider Christchurch area of New Zealand. Interviews were undertaken 20 widows and 20 widowers. The transcripts underwent a process of coding and narrative analysis. The themes identified within the narratives were developed into a collective story that described loneliness from the perspective of widowhood. The story followed a trajectory that began with an event or a change in lifestyle (widowhood) which was ascribed meaning by the individual. This precipitated an emotional response, specifically loneliness. As the story progressed, the process of renegotiating self-identity following bereavement was described. Loneliness was influenced further by the personal experience of physiological change, namely ageing, and the impact of societal expectations. The final stage of the collective story revealed a continuum of integration and adjustment to loneliness through adaptive and maladaptive coping responses, both informal and formal. Cultural influences shaped personal coping strategies and the perception of formal support.
2015-01-23T01:45:49ZMental Health Nurses' Understanding of the Concept of Self-Management of Borderline Personality Disorderhttp://hdl.handle.net/10523/5127
Mental Health Nurses' Understanding of the Concept of Self-Management of Borderline Personality Disorder
2014
Harrington, Karen
BACKGROUND
The recovery framework is held as a mainstay in mental health to guide clinical practice. One of the main concepts of the framework is self-management. Borderline personality disorder (BPD) is arguably the most stigmatized diagnosis within mental health nursing. While mental health nurses appear to have embraced the recovery framework, they have struggled to apply this framework to nursing practice for people with a diagnosis of BPD.
AIM
The objective of this study was to determine what mental health nurses understood the concept of self-management to mean in relation to a service user with a diagnosis of BPD.
METHOD
A sample of ten mental health nurses working within a large District Health Board Specialist Mental Health Services was interviewed using a semi-structured interview format. The data generated from these interviews was analysed using the general inductive approach resulting in 26 sub-themes. These sub-themes were the varying concepts that participants understood to be self-management and were organised into three over-arching themes.
RESULTS
The three resulting themes from the study were: self-management is self-responsibility; second, that self-management is self-awareness; and third, that self-management is maintaining safety.
CONCLUSION
The three themes represented the diverse understanding of self-management held by the study participants. The first and second themes, self-management is self-responsibility and self-management is increasing self-awareness, both fit with the recovery philosophy of client empowerment and required nurses to move from the paternalistic, dominant, medical model. The third theme, self-management is maintaining safety, did not fit with the recovery model. Nurses practicing with a goal of maintaining client safety as self-management, have yet to break free from the aforementioned parochial model and question the use of power employed as well as the goal of their practice. Nurses may have been unaware of the underlying beliefs and assumptions that have shaped their practice and may benefit from a reflective style of supervision. Nurses’ understanding of the concept of self-management for people with a diagnosis of borderline personality disorder was embedded in their practice and influenced the roles that they and the person played in their recovery journey.
2014-11-10T01:52:52ZThe Body Image of Women with Intellectual Disabilityhttp://hdl.handle.net/10523/5068
The Body Image of Women with Intellectual Disability
2014
Conder, Jennifer Ann
Women and their body image have been a focus for research throughout the latter part of the twentieth century; however, rarely does that research extend to women who may experience different lives through their identification as intellectually disabled. This doctoral thesis addresses a gap in understanding the way that New Zealand women with intellectual disability perceive their bodies and the historical, cultural and social influences affecting their perception.
Twenty-five women ranging in age from 21 to 65 years provided the data for this study. All women identified as having an intellectual disability and received some support to live with various levels of independence. Each woman participated in three interviews. Body image questions were included in semi- structured interview guidelines that explored aspects of the woman’s past and current life.
An interpretive constructivist approach was taken to understanding the women’s perception of their bodies. The information that the women shared has been viewed through a critical lens informed by both feminist and disability scholars. Thus the construction of the women’s bodies is interpreted rather than their own. In order to develop the construction, the interview transcripts of each woman were analysed from two perspectives. Firstly, the woman’s data were rewritten into her “story”, providing a preliminary understanding of how she constructed her body image. Secondly, all interviews were coded and themed utilising Braun and Clarke’s (Braun & Clarke, 2006) framework. This process provided a way to engage with the data and draw out the significant points that informed the women’s construction of their body.
The identification of three themes, “beauty and the body”, “a fit and functional body” and “a gendered body” that provide discrete perceptions of the women’s body, supports the contemporary view of multiple body images. Further analysis of the women’s body image suggested interplay between internal and external factors. Most women compared their body size to social standards of weight. Less typical of other women was their emphasis on their clean and tidy body as representing their competence and the comparatively infrequent and limited use of beauty practices. For many of the women, sexuality was ignored or controlled.
Lacan’s (2002) mirror stage, as an explanation of the psychological development of body image, is utilised to integrate an embodied conception of the women’s body image. Finally, and importantly for disability research, the idea of “becoming” is utilised to explore how the women are limited or perceive few possibilities for self-expression through their body. Through examining both possibilities and limitations the research gives direction to future policy and practice that impact on the lives of women with intellectual disability.
2014-10-27T19:45:34Z“I’m not a pill-taker”: Medication and meaning for older peoplehttp://hdl.handle.net/10523/5016
“I’m not a pill-taker”: Medication and meaning for older people
2014
Ritchie, Lorraine Helen
Background:
The philosophy of ageing in place has seen a greater emphasis on community care for older people. In New Zealand, access to assistance at home from health services begins with a comprehensive geriatric assessment, which includes medication management. This thesis examines specifically older participants’ self-management of medications and what medication-taking means to them.
Aims
1. To explore how older people make sense of their medication-taking and medication self-management.
2. To explore the value of a narrative approach/methodology in eliciting older people’s attitudes and practices in medication-taking.
3. To critically view how the meaning older people make of their medication self- management might influence policy and practice.
Methodology and Methods
The overarching methodological approach to this thesis is a narrative one. Twenty participants underwent two separate sets of interviews: a needs assessment interview guided by a standardised geriatric assessment tool, and a semi-structured interview about their practices and beliefs on medication-taking. In total, forty interviews with older participants who were living in their own homes in the community were analysed using narrative analysis and presenting data in the form of themes and case studies.
Results
Four key findings emerged from the analysis. These were the themes of:
1. Living with illness – the impact on lives and medication-taking
First and foremost, participants lived and coped with illness as part of their everyday living at home. Medication-taking was one of multiple consequences of the daily reality of living with a chronic illness. Any sense that participants made of their medication was in the first instance viewed through the lens of a recent illness, hospitalization, chronic pain or uncertainty of the future trajectory of the illness.
2. Trust and the older patient-doctor relationship
The majority of participants expressed a strong sense of trust in their doctor as the main prescriber of their medication. The doctor’s word and advice was law to most participants, who imbued their doctor with an authority and competence without question. Further, many also valued a ‘social’ relationship with their doctor where a personable interaction was able to exist largely due to longevity of relationship, but also a willingness to see the doctor as a person, not just a health professional in an objective transaction.
3. Everyday routines and strategies These showed resourcefulness, coping and adaptation. Participants demonstrated a variety of unique systems and strategies related to medication self-management, from sophisticated routines where medication was checked, administered and stored correctly through to haphazard and inconsistent patterns of self-administration. Strategies depended on their beliefs but also on life circumstances and the meaning and importance placed on medication. Participants coped variously with management of their medication in the same way they coped with other aspects of daily life at home such as preparing meals, showering and socialising. Managing medication was not seen by the participants in isolation from the lived daily context of everyday managing routines and strategies. Self-management of medication required the ability to navigate through layers of complex context. For some it was more important to comply with medication taking; for others it was not a priority.
4. Advice – formal and informal
Participants had valued relationships with others beyond doctors in relation to medication-taking. This was primarily with other formal health professionals such as pharmacists, but also on an ‘informal’ level, with family and friends. Some advice and recommendations came from surprising sources such as a bank teller or a women’s magazine. The gathering of information which informed medication-taking showed that older people’s lived context was far wider than a doctor-patient relationship. Views and attitudes of others all contributed to the sense older participants made of their medications.
Conclusion/implications for practice
Health services and professionals need to respect strategies and coping methods which older people have developed to self-manage medications and other aspects of their daily living. By listening to older people’s narratives of how they manage, health professionals can work with older people on their own terms starting with the voice of the older person as expert self-manager. Health professional education is necessary to raise awareness that meaning for older people is produced through narrative and that this is a key component of assessment and service delivery.
2014-10-06T00:48:07Z